Factors that Influence Effective Diarrhea Treatment Programs in Haitian Children

Abstract

Objectives: Childhood diarrhea is a major cause of morbidity and mortality in Haiti; a situation exacerbated by the cholera outbreak in 2010.  Oral rehydration salts (ORS), when combined with zinc (ORS-zinc), is effective in preventing death and reduces severity of illness—yet their combined use remains low. An intervention to expand delivery of ORS-zinc is underway. To guide the scale up of the intervention, we conducted a qualitative study to identify caregivers’, influencers’ and healthcare providers’ knowledge, attitudes and practices related to diarrhea and its treatment. Methods: Study conducted in two departments in Haiti: North West, where ORS-zinc distribution has already begun, and North, where ORS-zinc will be implemented in 2014. Using rapid ethnographic methods, we conducted 1) semi-structured interviews with both health workers of traditional and modern medicine (n=16), 2) facility observations where child diarrhea is treated (n=4), 3) six focus group discussions (FGD) with caregivers (n= 62) and influencers (n=39). Results: All modern and most traditional health workers recommended ORS in their practice, however, only those already receiving the intervention prescribed zinc while a few modern practitioners in the non-intervention group had heard of it. Facility observations demonstrated a gap in how the use of ORS-zinc is explained to patients. FGD showed that care seeking behaviour is strongly influenced by perceptions of the type of diarrhea and availability of healthcare provider. Conclusions: Knowledge and attitudes affect the prescription and use of ORS-zinc. These findings will affect the design of targeted behavior change interventions for scaling up ORS-zinc in northern Haiti.